Total hepatectomy and liver transplantation for metastatic neuroendocrine tumors of the pancreas – a single center experience with ten patients View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

1999-08

AUTHORS

H. Lang, H. J. Schlitt, H. Schmidt, P. Flemming, B. Nashan, G. F. W. Scheumann, K. J. Oldhafer, M. P. Manns, R. Raab

ABSTRACT

Background: Metastatic neuroendocrine pancreatic tumors have a poor prognosis. We have studied retrospectively the efficacy of liver transplantation as ultimate therapy of otherwise untreatable symptomatic neuroendocrine hepatic metastases originating in the pancreas. Methods: We reviewed our experience of liver transplantation (LTx) for hepatic metastases of neuroendocrine pancreatic tumors in ten patients. The indication for liver grafting was seen in cases of irresectable metastases and when patients were suffering from otherwise untreatable tumor-associated symptoms due to massive hormonal release or large intra-abdominal tumor bulk. Results: In four patients, the primary tumors had been removed before LTx, in five patients simultaneously with LTx and in one case 46 months after grafting. There was no operative mortality. After hepatectomy and LTx, all patients had complete relief of symptoms and all preoperatively increased hormonal levels returned to normal. In nine of ten patients, the transplant procedure had the potential for cure, whereas, in one patient, the primary tumor had remained in situ at LTx and was removed 46 months later by an R2-resection. At present, nine patients are alive with a median follow-up of 33 months (range 13.5 months to 117 months). The one patient in whom the primary tumor was removed after transplantation died due to massive intra-abdominal tumor spread 68 months after LTx. Currently, two patients are without evidence of disease, but one of them after re-operation because of lymph-node metastases 8 months after transplantation. The longest disease-free survival is now more than 7 years. In seven of nine patients, tumor recurred between 1.5 months and 48 months after transplantation. Conclusions: Patients with otherwise untreatable symptomatic neuroendocrine hepatic metastases of pancreatic origin may benefit from total hepatectomy and liver transplantation with regard to symptomatic relief and long-term survival, despite frequent recurrence of disease. In some patients, liver transplantation may even offer the chance for cure. More... »

PAGES

370-377

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s004230050216

DOI

http://dx.doi.org/10.1007/s004230050216

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1011511494

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/10473858


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66 longer disease-free survival
67 lymph-node metastases 8 months
68 massive hormonal release
69 massive intra-abdominal tumor
70 metastases 8 months
71 metastasis
72 metastatic neuroendocrine tumors
73 months
74 mortality
75 neuroendocrine hepatic metastases
76 neuroendocrine pancreatic tumors
77 neuroendocrine tumors
78 operative mortality
79 origin
80 pancreas
81 pancreatic origin
82 pancreatic tumors
83 patients
84 poor prognosis
85 potential
86 primary tumor
87 procedure
88 prognosis
89 recurrence
90 regard
91 release
92 relief
93 single center experience
94 situ
95 survival
96 symptomatic neuroendocrine hepatic metastases
97 symptomatic relief
98 symptoms
99 therapy
100 total hepatectomy
101 transplant procedure
102 transplantation
103 tumor bulk
104 tumor-associated symptoms
105 tumors
106 ultimate therapy
107 untreatable symptomatic neuroendocrine hepatic metastases
108 untreatable tumor-associated symptoms
109 years
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